HomeMy WebLinkAboutMortgage_Davis (13) I i Kok,
. "• �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coring !_
-ti, FOR DEDUCTION FROM ASSESSED VALUATION
s State Form by eg(R11 ntofL � IM
Presaibetl by Department of Local Government Finance • us. r
le a
INSTRUCTIONS:
To be filed in person or by mail. m filed ! : i(
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. /: ,.711!", Itr
Must be filed with the County Auditor or County Recorder of the county where the property is Iocatg18S0 c7 N t ! •I I OR
on or before January 5 of the immediately succeeding calendar year. I r County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see resuictions on reverse side) 1� — ' r
GREG R.AND LEAH R. DAVIS 5l (`i(
Taxi trio Key num /I al description I Rec rd number I Page nember
n�h a�-9 x-300 ooa ssv oa� l.�f �fuv,��s G� sr �e�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortg /Contract indebtedness unpaid as of Is the applicant e
March 1.current year y March 1.current year dale a appG t�[q,�/ I legal or equi owner?
po•r Ra n (6Yvdl lea_ y / ,�0 Yes ❑ No
If no.what is his/her exact share of interest? If owned with someone other than spouse;indicate with whom
If name on record is different than that of applicant.indicate below. Is the rty in question:Annually Assessed
eat Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name rtgagee or contraci seller n /) _
Q,{�5 t/IltQ, Coiyirn.trw Pli- '_-V1
Addre)of mortga ee or coot. r(nu tier and street.cM/,state.and ZIP c )
o ►�w moans Ulm I J W77ocP
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other / If yes.what county? I What Taxing District? Has this deduction been requested on proper e
county in Indiana? ❑ Yes No for cur re nt year? ❑ ❑
Yes No
I
COUNTY AUDITOR
Deduction approved in the amount at
20 20 1 20 20 20 20 20
Signature of County Auditor County I Date(month.day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
ov er c,act buyer of the aforementioned property on•-te applicaA•n is filed.
y•-tu Itov full name) '_�� I Date(own day, ar)
�.�. - / i 4 i a/CS7(3
Full resid• t address of applicant(number and street.city,stat ode) I
Id-f q IJ ) phew- Ku.h I Cb tCUTh z1-76aq
Person authorized by duly executed Power of Attorney or by IC 6-1.1-124.7 I Date(month.day,year)
Address of authorized person (number and street,city,state,and ZIP code)